Human immunodeficiency virus social work program at the Walter Reed Army Medical Center: A historical perspective

Military Medicine, Sep 2003 by Piotroski, Stanley S, Chapin, Mark G

Human immunodeficiency virus (HIV) infection has become a pandemic concern for many nations. When this disease first presented itself in a global manner in the early 1980s, it was accompanied by fear, denial, misunderstanding, social stigma, and a paucity of available support services. The U.S. Army was becoming increasingly aware of the potential impact HIV could have on the active forces. A tragic event involving the suicide of a young HIV-infected soldier resulted in the development of a comprehensive medical/psychosocial assessment and treatment program for HIV-infected service members and their families at the Walter Reed Army Metrical Center. Social work services played an integral role in the development of this program as this profession has done historically in meeting other emerging needs of the military. Special attention is given to the unique psychosocial issues and needs of the HIV-infected service member and the comprehensive and compassionate response of the military medical team with its significant social work contribution.

Introduction

During the early 1980s, a disease leading to enormous medical challenges and dramatic societal changes commenced to rear its ominous head within the United States. In San Francisco, health officials began reporting alarming medical information about a strange new viral illness. This virus was infecting increasing numbers of homosexual men, leaving them weak, debilitated, and immune deficient. The numbers of human immunodeficiency virus (HIV)-infected heterosexual men, women, and children were yet to be identified. Isolated reports of HIV-infected hemophiliac children were surfacing. The case of Ryan White would soon make national headlines, leading to federal funding and program development. The national news media were publishing numerous articles depicting the devastation of HIV and acquired immunodeficiency syndrome (AIDS). These articles served to heighten public awareness but also increased hysteria among the general population. In addition, the lack of epidemiological knowledge relating to routes of transmission contributed to an environment of apprehension and fear. Spiraling anxiety and ignorance prevailed among all walks of society, leaving the newly diagnosed in a state of acute emotional turmoil and social abandonment. Individuals diagnosed with HIV were socially stigmatized and thwarted in their efforts to reach out for emotional and social support that was afforded others faced with a life-threatening disease.

The military was becoming alarmingly aware that HIV had defense and foreign policy implications. A plan of action would have to be developed for the armed forces to establish administrative policy and treatment guidelines for the HIV-infected service members and their families. This was initially accomplished with the Department of Defense publication, The Department of Defense Guidelines for the HTLV III-Infected Service Member, in 1986.1 The current regulation, which directs the care and administrative support for HIV-infected service members, is AR 600-110.2

Early in the development of policies and treatment programs for HIV-infected service members, a tragic event occurred that spurred this process along at a rapid pace. HIV-positive soldiers were assigned to the Medical Holding Company at the Walter Reed Army Medical Center (WRAMC) where they would await a medical evaluation for HIV disease. A young, 19-year-old male soldier who had recently tested positive for HFV disease was brought from his unit to WRAMC for medical assessment. This young HIV-infected soldier became despondent and isolated and committed suicide. The Commanding General of WRAMC responded immediately and directed that in addition to the medical evaluation for HIV disease, a comprehensive psychosocial assessment and treatment program for the emotional components of HIV disease be incorporated into the evaluative process. The HIV evaluation program was to be initiated within a medical surgical ward under the auspices of the WRAMC Infectious Disease Service.

Army social work was summoned by the WRAMC medical command in 1985 to assist with this critical mission to develop a comprehensive psychosocial support program and prevent any further suicides. The HIV Social Work Service was initiated with one staff member, which increased to four, and currently has two professional social workers. This program formed the basis for the HIV Social Work Service that was to include the following elements: a psychosocial assessment and follow-up social work intervention; clinical and administrative command consultation; and consultation to Army policy makers. The HIV Social Work Service program culminated in an extraordinary opportunity for the social work profession to display its ability to meet emerging needs of the military establishment and to provide advocacy for a disenfranchised group within the U.S. Army.

This study explores the contribution of the social work profession when presented with an emergent need in a societal disenfranchised group represented within the U.S. Army at the advent of the AIDS epidemic. Special consideration is given to the unique psychosocial Stressors experienced by HIV-infected military members. This study will present information recognizing the adaptability of the professional military social worker to accommodate the psychosocial needs of the HIV-positive military member as medical advancements occurred with HIV disease treatment.